Keywords
1. Malnutrition in Gastric Cancer
2. Nutritional Assessment Tools
3. Nutritional Risk Screening
4. Patient-Generated Subjective Global Assessment
5. Global Leadership Initiative on Malnutrition
As malnutrition silently weaves its web around the lives of many battling gastric cancer, a newly published study in Clinical Nutrition ESPEN sheds light on the true prevalence of this condition among such patients. Authored by a team of researchers from Capital Medical University, Beijing, and Beijing Shijitan Hospital, this landmark study reveals that employing precise diagnostic techniques is not just a matter of identifying malnutrition, but significantly impacts the survival outcomes for patients with gastric cancer.
DOI: 10.1016/j.clnesp.2023.12.019
The study, titled “Bayesian diagnostic test evaluation and true prevalence estimation of malnutrition in gastric cancer patients,” provides a comprehensive examination of the accuracy and prognostic capabilities of three distinct nutritional tools. This research is especially crucial considering that gastric cancer, a pervasive public health issue, is compounded by the high incidence of malnourished patients involved, which calls for immediate and accurate assessment of their nutritional status. This can guide timely monitoring and interventions necessary for improving the overall treatment outcomes.
The research entailed the analysis of data from 1308 adult patients, all diagnosed with gastric cancer and recruited across multiple centers from July 2013 to July 2018. The researchers aimed to assess the patients’ nutritional status using three tools: Nutritional Risk Screening 2002 (NRS-2002), Patient-Generated Subjective Global Assessment (PG-SGA), and Global Leadership Initiative on Malnutrition (GLIM) criteria. The evaluation involved a Bayesian latent class model (LCM) to estimate the prevalence of malnutrition among the gastric cancer patients and the diagnostic sensitivity and specificity of the nutritional tools. Moreover, a Cox regression model was used to analyze the relationship between nutritional status and overall survival (OS) among these patients.
The findings were both alarming and instructive. According to the data, NRS-2002, PG-SGA, and GLIM identified 50.46%, 76.76%, and 68.81% of patients as malnourished or at risk of malnutrition, respectively. The Bayesian LCM exposed that the PG-SGA had the highest sensitivity, at an impressive 0.96, for malnutrition assessment, followed by the GLIM criteria at 0.78 and then NRS-2002 at 0.65. Essentially, PG-SGA emerged as the most reliable tool for diagnosing malnutrition among these patients.
Perhaps most importantly, the study uncovered that malnutrition, or the risk of it, stood as an independent prognostic factor for overall survival in gastric cancer patients. Employing any one of these tools actually improved the survival prediction integrated into the TNM staging system, which is traditionally utilized to stage different types of cancer. Thus, the PG-SGA is considered the optimum solution for diagnosing malnutrition accurately, whereas NRS-2002 is deemed suitable for nutritional screening in busy clinical settings. The research illuminates the necessity of direct utilization of GLIM for nutritional assessment due to the lower sensitivity of NRS-2002. It draws attention to customized actions associated with each nutritional tool, though it emphasizes the requirement for further research.
The authors Zheng Xite, Ruan Xiaoli, Wang Xiaonan, Zhang Xiaorui, Zang Zhaoping, Wang Yijie, Gao Ran, Wei Tong, Zhu Lingyan, Zhang Yijun, Li Quanmei, Liu Fen, and Shi Hanping, representing various influential bodies of clinical and nutritional research and gastrointestinal surgery, contribute compelling evidence for change in clinical practice. Their meticulous work, informal affiliation with the INSCOC Group, and multidisciplinary expertise bring to the forefront the pressing issue of overlooked malnutrition among those fighting stomach cancer.
This extensive investigation into the interconnection between nutritional assessment and clinical outcomes in common cancers is groundbreaking. It not only poses an urgent call for optimized nutritional intervention strategies in cancer care but also for broader implementation of validated tools for early detection of malnutrition.
The potential implications of this research span various facets of clinical care, as it highlights the necessity to integrate nutritional assessments into the traditional cancer care regime. It underscores the role of early detection and prompt intervention in improving patient outcomes and survival, which draws much-needed attention from healthcare providers, oncologists, and dietitians alike.
Furthermore, the stake that malnutrition holds over survival odds in gastric cancer patients advocates for a more profound inclusion of nutritional support in comprehensive cancer therapy. It champions a new paradigm wherein nutrition is viewed as a cornerstone of oncological treatment, aligning with a more holistic approach to cancer care.
The incisive report by the researchers around © Copyright 2023 by Elsevier Ltd. delineates a robust framework for advancing clinical nutrition in relation to cancer treatment. It integrates the specificity of the diagnosis with the sensitivity of individual patient needs. This precision not only affirms the role of timely, accurate malnutrition identification but serves as a clarion call to reckon with the full spectrum of care considerations that could refine the future of cancer treatments and patient recovery rates.
References
1. Zhang, Y., Zheng, X., Ruan, X., Wang, X., Zhang, X., Zang, Z., Wang, Y., Gao, R., Wei, T., Zhu, L., Zhang, Y., Li, Q., Liu, F., & Shi, H. (2024). Bayesian diagnostic test evaluation and true prevalence estimation of malnutrition in gastric cancer patients. Clin Nutr ESPEN, 59, 436-443. doi: 10.1016/j.clnesp.2023.12.019.
2. Arends, J., Baracos, V., Bertz, H., Bozzetti, F., Calder, P. C., Deutz, N. E. P., … & ESPEN expert group. (2017). ESPEN guidelines on nutrition in cancer patients. Clinical Nutrition, 36(1), 11–48. doi:10.1016/j.clnu.2016.07.015.
3. Skipworth, R. J. E., Stewart, G. D., Dejong, C. H. C., Preston, T., & Fearon, K. C. H. (2010). Pathophysiology of cancer cachexia: much more than host-tumour interaction? Clinical Nutrition (Edinburgh, Scotland), 26(6), 667-676. doi:10.1016/j.clnu.2007.03.011.
4. Cederholm, T., Jensen, G. L., Correia, M. I. T. D., Gonzalez, M. C., Fukushima, R., Higashiguchi, T., … & ESPEN. (2019). GLIM criteria for the diagnosis of malnutrition – A consensus report from the global clinical nutrition community. Clinical Nutrition, 38(1), 1-9. doi:10.1016/j.clnu.2018.08.002.
5. Bauer, J., Capra, S., & Ferguson, M. (2002). Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. European Journal of Clinical Nutrition, 56(8), 779-785. doi:10.1038/sj.ejcn.1601412.
6. Kondrup, J., Rasmussen, H. H., Hamberg, O., & Stanga, Z. (2003). Nutritional Risk Screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clinical Nutrition, 22(3), 321-336. doi:10.1016/S0261-5614(02)00214-5.
Declaration of competing interest:
None reported.
The elucidation provided by this eminent group of researchers emphasizes not only the importance of nutritional assessment in cancer patients but brings to light the notion that such assessments should be tailored and specifically targeted. As such, this study stands as a significant contribution to the literature and serves as a foundation for future research in clinical nutrition and its integration into the cancer care continuum.